Following my first outreach trip

It was last Thursday that I woke up at 4am because I was so excited, and because I had had a dream about armed militants coming to our compound. I impressed myself by following all the relevant safety protocols, namely calming the situation, and give them our money.

It was last Thursday that I woke up at 4am because I was so excited, and because I had had a dream about armed militants coming to our compound. I impressed myself by following all the relevant safety protocols, namely calming the situation, and give them our money. This Larium-fuelled rude awakening left me two hours to ponder the day ahead. My first trip out on outreach. That seems like a long time ago as I sit here on a Sunday night listening to Pink Floyd. Alone in my little office, typing to the whirl of the small fan that keeps the sweat from beading and breaking on my forehead,  and mentally preparing myself for another roller-coaster week of organized chaos.

OUTREACH/Mobile Clinic

By 6am I had borrowed the drill and screws I needed from our quiet but kind technician-logistician-assistant, and we were driving out into the cool morning. We headed up the northern axis, in the direction of Poala and Boguila. Past the first road barricade manned by town youth, who let us pass, then the UN MINUSCA  barricade at the edge of Bossangoa. Raised bar and raised hand and we were out into the unknown. The furthest I had been since my arrival three weeks ago was the airstrip. Now, we were two vehicles and two expats, one in each for security reasons, yet this felt liberating. Armed groups or not, I needed this freedom.

After the UN check point we forked right and onto the more northeastern axis as the day's destinations were Kaboro and the Bowaye. The outreach nurse and the team were following their usual routine: to check up on the health post, assess patients who can’t reach Bossangoa, and to check in with the local staff they have trained. These health workers run the posts, with remote support from MSF, and are usually elected by the community. A few hours at each spot is all there is time for due to the distance, access, and the 6pm curfew. This is enough time to check the worst cases, decide who needs to be transported back to Bossangoa, keep an eye of the professionalism of the local staff and speak to the villagers about their medical concerns. Everyone simply does as much as they can. I was there to fix some locks for the Kaboro health post which had suffered damage at the hands of some roaming Peuhl herders. They had passed by and burnt the tables as fire wood. The padlocks I was going to fit would not stop the determined theft, but such opportunism, we hoped, would be deterred.

As we flew down the potted orange roads I couldn’t help smiling. For me at that moment, it was the most beautiful morning I could imagine. The cool air, the clear sky, the brush and fields and undergrowth flashing past, the adrenaline and the speed were shaking out my compound lethargy. I chatted away happily with my driver in pidgin French with lots of energy, hand gestures and pointing at things. I seem to have lengthy conversations with people but I understand such a small amount of the answers that I never really know what we are talking about. But in this instance we communicated, regardless. And I even learned a little Sango. Bara ala kuye to say hi to the groups of kids that sprint across the dirt as we flash past, white passenger in a white Land Cruiser. Their insistent acknowledgment, similarly; exhausting, and brilliantly bizarre.  I waved ceaselessly at these insatiable children as they seemed so happy to run towards us for this game, it would have been mean not to oblige with some response. It made me acutely aware of how many young children there were.

Along the route we also passed people carrying bags of manioc, the staple carb, on their heads to market. Later on, away from Bossangoa, I saw young boys and older men with spears, long metal shafts with diamond shared heads. For hunting, my driver told me. I pointed out a boy no older than 7, imagining him catching anything bigger than a lizard. Ok, maybe not always for hunting, but for protection, he conceded.

After three fast, dusty and wild hours on the road, we arrived at that first spot: a small brick building, with three rooms off of a small porch, where the health workers had set up their table. A small scale for weighing kids for malnutrition hung from the porch roof and the outreach nurse began discussing illness with the mothers. Other young women and men loitered, either to watch or to share less common issues. In one case a young women had a bead stuck deep in her ear. High risk of perforating the ear drum limited our involvement; she was advised to try to soak it out. Or head to the hospital in Bossangoa that we run alongside the Ministry of Health (MOH).

Everyone here is malnourished, has malaria, and their bloated bellies say parasites. Acute malnutrition is visually remarkable, with orange brittle hair highlighting the desperate need for protein. The next stage is the skin swelling and essentially melting as the cells break down. We are the Plumpy Nut gods, although this is not a position of divine clarity. We are bringers of this malnutrition food, with the direct burst of nutrients a desperate body needs. Or, the body of a greedy mother wants, or that the hands of market sellers, whose procurement tactics are ever creative, crave. The malnutrition topic is one of much contention, why are these people not eating properly? Is it conflict affecting regular agricultural planting, is it poverty meaning that all food is sold rather than eaten? Is it lack of education, families living on manyok root, which is filling but holds limited nutrients? I am no expert, but, like many things, it is a combination of causes. But it is hard to see these children when you know there is fruit and vegetables around, and fish in the rivers…

We stopped at this first sight for an hour or so and I used the battery-powered drill to attach three padlocks. An older local man, who smelled of homemade liquor, called and spoke a word or two of English he remembered from school, and was so impressed by this tool that I let him finish a few of the screws. He was really excited, and our audience was somewhat bemused, and fascinated, by me as much as by the tool. I think they were impressed, but also thought I was at least a little weird.

We drove on from Kaboro to Bowaye, the next village where I watched the Ministry of Health workers conduct malaria tests before wandering through the small market. I had nothing specific to do here apart from fulfilling my role as second expat. So I drank a shot of the local spirit (which is distilled in old oil drums and supposedly passed through animal intestine) to the amusement of the drinkers, both men and women, and bought a bag full of oranges. I took the oranges back to share with the drivers and the medics. We passed the hour peeling and spitting seeds, as one at a time the patients moved from under the tree, to the inside of the church that served as the health post for market day. Market day fills the small village with people and stalls, completely blocking off the actual health post. So the team seems to have adapted.

On one wall of the church’s dim interior a picture of a helicopter is scrawled. A cute childish image, simple lines picking out the form, the windows, the propellers. Then you realize why that child drew a helicopter. Then you remember the chaos and violence of these last years. What other images has this kid stored?

At 1:30 it was time to head back, this rule means even in the rainy season the team should have enough time to get back before curfew. Being out and about of these roads late is asking for trouble. If not from roaming militias, then from common criminals. So, we jumped back in the Land Cruisers and rallied our way back south again. It was hot by now and the sun baking down through the glass was only alleviated by the rush of air through my open window. But with the air came dust, plastering everything orange. My driver focused on his speedy navigation of the deteriorated roads and I watched the road, and dust, and kids waving all with the fierce intensity of a slightly sun-stroked brain. So, in silence we flew the 2.5 hours home, faster this time than on the way out. In the other 4x4 we had two babies, and their mothers, who needed to go to the hospital. One for pneumonia, the other a prenatal infection. Through the orange clouds and through the maze of streamlets and pot holes and cracks and the odd person we rushed. Context aside, it was fantastic.